The majority of residents in a care homes suffer with dementia and have to pay the full cost of their care home fees. However, if a resident is found eligible for NHS continuing healthcare funding the NHS is responsible for full payment of that resident’s care home fees.
Often in our Nursing Care Department, new and existing clients ask whether the diagnosis of dementia is sufficient for NHS continuing healthcare funding to be awarded. The simple answer is that unfortunately, the diagnosis of any condition, including dementia, is not enough for NHS continuing healthcare funding to be awarded.
Eligibility for NHS continuing healthcare funding is person centred and awarded based on the level and type of care required by an individual and not a specific diagnosis. However, the diagnosis of dementia is an important factor which is taken into account because of the impact the condition has on an individual’s mental functionality and their needs as a whole.
To be found eligible for NHS continuing healthcare funding, an individual’s needs must meet the eligibility criteria. There is a two stage assessment process which must be completed. Firstly, a checklist assessment is completed. A checklist assessment is an initial screening tool to determine whether an individual’s need may qualify for NHS continuing healthcare funding. If this stage is passed, a Decision Support Tool (DST) will be completed. The DST is a full assessment which is more critical when considering a Patient’s needs.
You can read more about the two stages of the assessment in our previous blog post NHS continuing healthcare: What makes someone eligible.
Dementia obviously has an impact on an individual’s mental functionality which results in episodes of confusion, disorientation, short-term and long-term memory loss. However, depending on the severity of the condition, dementia may also affect other aspects of an individual’s needs. I’ve listed a number of examples of how dementia can interact with other aspects of an individual’s care, however, the effect of dementia is not limited to these examples and is of course different for everybody.
You can see from the above that dementia therefore has an impact on an individual’s care needs. The nature of the condition adds additional layers of complexity to an individual’s care. The overlap between needs may require a higher level of support from professionals such as a GP or the community mental health team to manage, also providing evidence that their care is intense.
In summary, the diagnosis of dementia alone does not result in NHS continuing healthcare funding, but the impact the condition has on an individual’s care requirements should be discussed in detail during an assessment.
The Hugh James Nursing Care department has extensive knowledge and expertise regarding NHS continuing healthcare funding; we deal with both retrospective and on-going claims for funding.
Our lawyers are capable of assisting you from the start of your claim, right to the end. If you are considering registering a claim for NHS continuing healthcare funding on behalf of a relative, we can ensure that the process takes place as quickly as possible and that any assessments completed are procedurally fair. If you have already registered a claim for NHS continuing healthcare funding, we are able to step in and assist you for the remainder of the process. We are trained in evaluating unfavourable assessments and analysing essential information from medical records which may result in a positive decision for your relative.
In most cases, we are able to take instructions under a “no win, no fee” agreement. This means that you are only required to meet our costs if your case is successful. In this event, our costs would be deducted from any reimbursement that you receive from the NHS. However, the availability of this agreement is dependent on your relative’s needs.
Please get in touch with the Hugh James Nursing Department for more information by calling 0800 988 2373 or completing an enquiry form here.